Abstract
Background
There is currently a paucity of research comparing the clinical outcomes of single-incision laparoscopic colectomy (SILC) with those obtained with multiport laparoscopic colectomy (MLC). This meta-analysis aimed to examine whether SILC shows real benefits over MLC, especially in terms of feasibility, safety, and oncological adequacy.
Methods
A literature review of studies comparing SILC and MLC has been performed which looked at the following outcomes: mortality, morbidity, and oncological parameters of adequacy, as well as other potential benefits and drawbacks. Standardized mean difference for continuous variables and odds ratios for qualitative variables were calculated.
Results
Thirty studies comparing SILC and MLC were reviewed: two prospective randomized clinical trials (RCTs), eight prospective studies, and 20 retrospective comparative observational studies. Overall, in a cohort of 3502 patients who underwent surgery, SILC was used in 1068 cases (30.5 %) and MLC was used in 2434 cases (69.5 %). Mean intraoperative blood loss was significantly lower when the SILC procedure had been used (75.06 vs. 91.45 ml, P = 0.03); bowel function recovered significantly earlier in the SILC patients (1.96 vs. 2.15 days, P = 0.03); mean postoperative hospital stay was significantly shorter in the SILC group (5.55 vs. 6.60 days, P = 0.0005); and length of skin incision was significantly shorter in SILC patients (3.98 vs. 5.28 cm, P = 0.01). However, in the latter four outcomes, evidence of heterogeneity was found. In contrast, MLC showed significantly better results when compared to SILC in terms of distal free margins (12.26 vs. 10.98 cm, P = 0.01).
Conclusions
SILC could be considered as a safe and feasible alternative to MLC in experienced hands. Further evidence for this surgical procedure should be assessed in the form of high-quality RCTs, with additional focus on its use in low rectal cancer resection.
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Acknowledgments
We thank Ms. Jessica Thompson, BMsC (University of Dundee, UK) for revising the English.
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Podda M was involved in study design, acquisition, interpretation, and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published; Saba A was involved in acquisition, interpretation, and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published; Porru F was involved in interpretation and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published; Pisanu A was involved in study design, acquisition, interpretation, and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published.
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Mauro Podda, Alessandra Saba, Federica Porru, and Adolfo Pisanu have no conflicts of interest or financial ties to disclose.
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Podda, M., Saba, A., Porru, F. et al. Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc 30, 4697–4720 (2016). https://doi.org/10.1007/s00464-016-4812-2
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DOI: https://doi.org/10.1007/s00464-016-4812-2